The Value Of Aggressive Diuretics Therapy In The Acute Decompensated Stage Of Chronic Heart Failure

ObjectiveThe aim of this study was to evaluate both effective and e security of aggressive diuretic therapy in the acute decompensated stage of chronic heart failure,and its impact on the patient's hospitionzation days and charge.MethodsInpatients with CHF and the New York Association(NYHA) class was III or IV in our cardiovascular department from January 1st 2006 to September 1st 2007 were included in this retrospective analysis. The data including blood pressure, heart rate, 24-hour urine, laboratory measurements, echocardiogramphic parameters of patients were recorded. The patients were divide into two groups according to 24-hour urine which was collected the day after admission. The 24-hour urine equivalent or more than 2400ml was defined as aggressive diuretic therapy(ADT), and less than 2400ml was defined as non-aggressive diuretic therapy(NADT). The hospitionzation day and charge were compared between the two groups, the biochemical parameters and vital sign were also compared before and after aggressive diuretic therapy. Measurement data with or without Gaussian distribution was expressed with mean±standard deviation ( x±s) or median respectively. Measurrement data which was or was not Gaussian distribution and homoscedasticity was statisticed with T test or the Mann-Whitney U test. Numeration data was statisticed with X2 test .The P value which lower than 0.05 was significant difference.Results1 195 patients were enrolled in our study, there were 73 and 122 patients in ADT group and in NADT group respectively. It was not statistically different in the etiology,age, gender, biochemical parameters, blood pressure, heart rate and heart function (P> 0.05). 2 The left ventricular ejection fraction (LVEF) in ADT group was lower than NADT group(44.62%±17.03%vs 52.84%±17.51%,P<0.01)。3 The median hospitalization days, total charge and average charge in ADT group was less than those in NADT group(11d vs 16d;$8483 vs $12182;$721.1/d vs $854.4/d,P all<0.05).4 The biochemical parameters (electrolytes, creatinine and urea nitrogen) and heart rate were no significant change before and after aggressive therapy. The median both SBP and DBP were reduced significantly after aggressive therapy(118.2±16.9 mmHg vs 127.1±24.9 mmHg;72 mmHg vs 80 mmHg,Pall<0.05).There was not hypotension symptom such as dizziness and chest distress in all patients.5 The death patients in the ADT group were lower than those in the NADT group(1 vs 12, P<0.05). ConclusionAggressive diuretic therapy in the acute decompensated stage of CHF patients is both safe and effective, furthermore, can shorten hospitalization day and reduce hospitalization charge ,which is better in the cost-effectiveness..